Rare Complication Of Acute Pancreatitis Research Articles

Development of a nomogram for predicting pancreatic portal hypertension in patients with acute pancreatitis: a retrospective study

IntroductionPancreatic portal hypertension (PPH) is a rare complication of acute pancreatitis (AP) that can lead to severe gastrointestinal bleeding. The risk factors associated with PPH, as well as the overall...

Multiple giant pancreatic pseudocysts, a rare complication of acute pancreatitis – A case report

A 34-year-old alcoholic male presented to our outpatient department with a complaint of persistent epigastric pain, radiating to the back with a swelling in the upper abdomen. He had 2 similar episodes in the past for which he was conservatively managed along the lines of acute pancreatitis. Now on physical examination, the patient had a massive lump in the upper abdomen reaching below the umbilicus. Examination findings were confirmed by computed tomography - abdomen (Plain and Contrast), two 13×10×09 cm and 9×8×7.8 cm, cystic lesions (Noncommunicating) were seen abutting the posterior wall of the stomach and into each other, suggestive of mature pseudocysts of the pancreas. The patient was admitted and after necessary investigations, surgical cystogastrostomy was done for the lower pseudocyst and cystocystostomy for the upper pseudocyst. The patient was discharged 5 days later with no complications. This case shows that multiple pseudocysts, a relatively rare complication of acute pancreatitis, are one of the differentials of acute abdomen. The treatment is a therapeutic challenge that depends on location, size, number as well as their relation to one another. Good drainage prevents resection procedures and further complications (exocrine and endocrine insufficiency).

Rare complications of acute pancreatitis: Clinical cases

Background. Acute pancreatitis is recognized as a common disease, occasionally accompanied by the development of local complications that require surgical debridement. Rare complications of pancreatitis may occur in clinical practice, which is one of the reasons for their untimely diagnosis and treatment. Pancreaticopleural fistula and high small bowel obstruction develop in less than 1% of acute pancreatitis cases. Therefore, possible options for management of these complications are considered valuable. Description of clinical cases. The clinical examples, provided in the present paper, describe pancreaticopleural fistula and high small bowel obstruction that develop against the peripancreatic mass in the abdominal cavity. Patient K., 44, was hospitalized to the Regional Clinical Hospital of Emergency Medical Care, Krasnodar Krai, and preliminary diagnosed with bilateral hydrothorax and type II respiratory failure; pleural puncture was performed. Following the extended examination, a clinical diagnosis was made as follows: “Acute necrotic pancreatitis spreading to a pancreatic tail cyst. Reactive double pleurisy”. The postoperative period was indicated with repeated recurrence of right hydrothorax, and pancreaticopleural fistula (diagnosed by measuring amylase activity in the brown fluid effused from the right pleural cavity, which appeared to be 41216 IU/l (not normally determined)). The right pleural cavity and pseudocyst of the pancreatic tail were drained, resulting in obliteration of the pancreatbcopleural fistula. Patient V., 50, was hospitalized and transferred to the surgical department of the Regional Clinical Hospital No. 2, Krasnodar Krai, and diagnosed with “pancreonecrosis, extensive purulent-necrotic peripancreatitis.” The patient underwent puncture-drainage treatment. The postoperative period was complicated by acute small bowel obstruction. Surgical treatment involved Braun enteroesterostomy. The patient recovered. Conclusion. Pancreaticopleural fistula refers to a rare complication of acute pancreatitis, manifested by hydrothorax. Its diagnosis is based on the determination of amylase activity in the effusion. Drainage of the pleural cavity and pancreatic pseudocyst contributes to obliteration of the fistula. The intestinal obstruction, another complication of pancreatitis, requires open surgical treatment when a conservative therapy appears ineffective.

Mortality Trends, Outcomes, and Predictors of Portal Vein Thrombosis in Acute Pancreatitis Patients: A Propensity-Matched National Study.

Portal vein thrombosis (PVT) is a rare complication of acute pancreatitis (AP) and might be associated with worse outcomes. We aimed to study trends, outcomes, and predictors of PVT in AP patients. The National Inpatient Sample database was utilized to identify the adult patients (≥ 18years) with primary diagnosis of AP from 2004 to 2013 using International Classification of Disease, Ninth Revision. Patients with and without PVT were entered into propensity matching model based on baseline variables. Outcomes were compared between both groups and predictors of PVT in AP were identified. Among the total of 2,389,337 AP cases, 7046 (0.3%) had associated PVT. The overall mortality of AP decreased throughout the study period (p trend ≤ 0.0001), whereas mortality of AP with PVT remained stable (1-5.7%, p trend = 0.3). After propensity matching, AP patients with PVT patients had significantly higher in-hospital mortality (3.3% vs. 1.2%), AKI (13.4% vs. 7.7%), shock (6.9% vs. 2.5%), and need for mechanical ventilation (9.2% vs. 2.5%) along with mean higher cost of hospitalization and length of stay (p < 0.001 for all). Lower age (Odd ratio [OR] 0.99), female (OR 0.75), and gallstone pancreatitis (OR 0.79) were negative predictors, whereas alcoholic pancreatitis (OR 1.51), cirrhosis (OR 2.19), CCI > 2 (OR 1.81), and chronic pancreatitis (OR 2.28) were positive predictors of PVT (p < 0.001 for all) in AP patients. PVT in AP is associated with significantly higher risk of death, AKI, shock, and need for mechanical ventilation. Chronic and alcoholic pancreatitis is associated with higher risk of PVT in AP.

Incidence and outcomes of pancreatic encephalopathy in patients with acute pancreatitis: a systematic review and meta-analysis.

Pancreatic encephalopathy (PE) is a lethal complication of acute pancreatitis (AP), but its clinical characteristics and prognosis remain obscure. Herein, we performed a systematic review and meta-analysis to evaluate the incidence and outcomes of PE in AP patients. PubMed, EMBASE, and China National Knowledge Infrastructure were searched. Based on the data from cohort studies, the incidence and mortality of PE in AP patients were pooled. Based on the individual data from case reports, logistic regression analyses were performed to identify the risk factors for death in PE patients. Among 6702 papers initially identified, 148 were included. Based on 68 cohort studies, the pooled incidence and mortality of PE in AP patients were 11% and 43%, respectively. The causes of death were clearly reported in 282 patients, of which the most common was multiple organ failure (n = 197). Based on 80 case reports, 114 AP patients with PE were included. The causes of death were clearly reported in 19 patients, of which the most common was multiple organ failure (n = 8). Univariate analyses showed that multiple organ failure (OR = 5.946; p = 0.009) and chronic cholecystitis (OR = 5.400; p = 0.008) were the significant risk factors of death among patients with PE. PE is not a rare complication of AP and indicates poor prognosis. Such a high mortality of PE patients may be attributed to its coexistence of multiple organ failure.

1097A: THERAPEUTIC PLASMA EXCHANGE FOR THROMBOTIC MICROANGIOPATHY ASSOCIATED WITH PANCREATITIS IN A CHILD

Introduction: Thrombotic microangiopathy (TMA) is characterized by thrombocytopenia and microangiopathic hemolytic anemia (MAHA). These features reflect the presence of an active microvascular endotheliopathy. TMA has been reported as a rare complication of acute pancreatitis in adults, with good outcomes after therapeutic plasma exchange (TPE). Sparse pediatric literature addresses the association of TMA and pancreatitis, or the merit of TPE for this indication. Description: A 13-year-old obese male with no previous medical history was admitted to the pediatric intensive care unit for management of acute pancreatitis and kidney injury after two days of abdominal pain, nausea, emesis, and decreased urine output. After fluid resuscitation, his initial labs revealed a lipase of 8520U/L, AST 153U/L, ALT 150U/L, Hgb 14g/dL, WBC 23,000/uL, Platelets 58,000/uL, INR 1.3, BUN 37mg/dL and Cr 4.06mg/dL. A non-contrast CT scan confirmed radiographic evidence of acute pancreatitis. He was afebrile, with stable hemodynamics and a reassuring neurological exam. His hemoglobin decreased to 10.8g/dL 24 hours after admission with subsequent workup suggestive of hemolysis (haptoglobin < 30mg/dL, LDH 4898U/L, schistocytes on peripheral blood smear). A diagnosis of MAHA with thrombocytopenia was established and TPE was initiated. Common underlying conditions associated with TMA such as disseminated intravascular coagulation, infection, drug-induced, autoimmune disorders and malignancy were addressed and ruled out. Complement levels (C3 and C4) were normal, direct/indirect Coombs were negative and ADAMTS13 activity was normal (>60%). The patient received three days of TPE with improvement in platelet counts to 102,000/uL and decrease in LDH to 486U/L after the third session. Renal replacement therapy (RRT) was required for nine days after TPE with good recovery of renal function. He was discharged on hospital day 19 with downtrending Cr 0.78mg/dL and lipase 53U/L. He was tolerating a regular diet without volume restriction prior to discharge. Discussion: Thrombocytopenia and MAHA should raise a suspicion for TMA in children presenting with acute pancreatitis. Acute renal failure requiring RRT is a frequent comorbidity. TPE with RRT may be effective and lifesaving in these patients.

S1720 Diabetic Ketoacidosis as a Rare Complication of Alcoholic Pancreatitis in a Previously Euglycemic Patient

Introduction: Acute alcoholic pancreatitis is an acute inflammation of the pancreas secondary to alcohol intake due to autodigestion from an increase in pancreatic enzyme release. Most commonly due to gallstones, alcohol intake, and hypertriglyceridemia, pancreatitis commonly presents with severe epigastric abdominal pain, nausea and vomiting and is managed with aggressive intravenous (IV) fluid resuscitation. Some complications include acute respiratory distress syndrome and compartment syndrome. A very rare complication of acute pancreatitis is diabetic ketoacidosis (DKA), especially in patients without a history of diabetes mellitus. Case Description/Methods: A 25-year-old female with a medical history significant for alcohol abuse presented with nausea, vomiting, and abdominal pain for 2 days. The patient reported drinking one pint of liquor per day. She was tachycardic with a heart rate of 115 and other vitals were normal. Significant laboratory studies showed a lipase of 1715, aspartate transaminase of 292, alanine transaminase of 155, glucose of 540, venous pH of 7.277, bicarbonate of 9, anion gap of 21, and beta-hydroxybutyrate of 5.1. A computed tomography scan of her abdomen and pelvis without IV contrast showed edematous and inflammatory changes in the tail of the pancreas and severe hepatic steatosis (Figure). The patient was managed with aggressive IV fluids and IV insulin infusion. Her abdominal pain and anion gap resolved on day 2 of admission and she was able to tolerate a diet. Glycated hemoglobin (HbA1c) returned a value of 4.7 and C-peptide was low at < 0.10; the subsequent pancreatic antibody panel was negative. The patient was seen in the clinic 6 months later and HbA1c at that time was 4.8. Discussion: This case illustrates DKA as a rare complication of acute pancreatitis. It provides an example of why a high level of suspicion for DKA should be present in patients presenting with alcoholic pancreatitis even in the absence of any diabetic history. Though there is no definitive mechanism of action for this presentation, it is likely from a combination of pancreatic beta-cell destruction and counter-regulatory hormone effects. Pancreatic beta-cell destruction causes impaired insulin production, leading to acute hyperglycemia. Furthermore, as acute pancreatitis can lead to severe intravascular depletion, increased secretion of counter-regulatory hormones such as cortisol and glucagon, in combination with impaired insulin secretion, can precipitate DKA in such a scenario.Figure 1.: CT abdomen without contrast demonstrating edematous and inflammatory changes in the tail of the pancreas.

A Rare Cause of Peri-esophageal Cystic Lesion

A Rare Cause of Peri-esophageal Cystic Lesion

S1620 A Symptomatic Posterior Mediastinal Space Pseudocyst Managed by Cystgastrostomy Through a Hiatal Hernia

Introduction: Pseudocysts are seen after acute pancreatitis (AP) and consist of collections of pancreatic secretions surrounded by a fibrous wall. Mediastinal extension of pseudocysts is a rare complication of AP. Here we describe the unique case of a large pseudocyst that extended along a hiatal hernia sac resulting in chest pain and dysphagia, requiring cystgastrostomy in the posterior mediastinal space. Case Description/Methods: A 64-year-old female with a history of a large hiatal hernia (HH) presented to the emergency room (ER) with gradual onset retrosternal pain and associated dysphagia of 1 week duration. She had a recent hospitalization for AP two months earlier. In the ER, vital signs were within normal limits. Cardiac evaluation, complete blood count, and comprehensive metabolic panel were unremarkable. Abdominal computed tomography revealed a 7 x 6.2 cm peripancreatic fluid collection extending through the diaphragm in the posterior mediastinal space, resulting in mass effect on the distal esophagus and HH sac (Figure 1A-C). Upper endoscopy revealed extrinsic-appearing narrowing in the distal esophagus immediately proximal to a 5 cm Hill grade IV HH. Endosonography (EUS) guided cystgastrostomy was successfully performed using a 10 mm x 10 mm electrocautery enhanced lumen apposing metal stent (LAMS). Post-procedure the patient reported symptomatic relief and was admitted for overnight observation. Repeat cross sectional imaging revealed significant reduction in the size of the pseudocyst (Figure 1D). EUS two weeks later revealed complete pseudocyst resolution and the LAMS was removed. Discussion: Mediastinal extension of a pseudocyst is a rare complication of acute pancreatitis. In prior reports, mediastinal pseudocysts have been managed by endoscopic aspiration, placement of plastic stents, or surgical drainage. To our knowledge, this is the first case of a cystgastrostomy performed through a hiatal hernia to drain a pseudocyst in the posterior mediastinum.Figure 1.: Axial (A) and coronal (B and C) views of the CT scan revealed a large pseudocyst extending into the posterior mediastinal space. The sagittal view (D) showed the lumen-apposing metal stent draining the pseudocyst into the hiatal hernia sac.

S1603 Intrahepatic Pancreatic Pseudocyst: A Rare Complication of Acute Pancreatitis

S1603 Intrahepatic Pancreatic Pseudocyst: A Rare Complication of Acute Pancreatitis

I CANNOT SEE YOUR FACE! A CASE OF PURTSCHER DISEASE

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Purtscher-like retinopathy is an acquired form of retinopathy due to hemorrhagic or vasoocclusive vasculopathy associated with acute pancreatitis and other systemic diseases 1. It is associated with severe vision. Recent studies suggested ophthalmoscopy performed within first 24 hours of developing acute pancreatitis was a good indicator for predictor of disease evolution, outcome and overall poor prognosis 2. We present a rare case of a young African American male who had experienced acute vision loss in the setting of severe alcoholic pancreatitis. CASE PRESENTATION: 34-year-old African American male with a history of alcoholic dependence presents with abdominal pain. His last drink was 36 hours ago. It's described as sharp and radiating to his back. He denies any other ingestions or drug use. On presentation, vital signs show that he is mildly hypertensive, but otherwise within normal limits. Physical exam reveals epigastric tenderness on palpation with positive bowel signs, negative murphy sign, cullens sign and gray turners sign. Labs were significant for an elevated lipase as well as liver enzymes. No significant osmolar gap. Intravenous fluids were provided as well as pain control and patient was placed on a withdrawal assessment scale. Within 12 hours of admission, he started to experience alcoholic hallucinosis with decreased visual acuity and inability to recognize facial features. Fundoscopy revealed retinal whitening bilaterally, Intraretinal flame heme along inferior arcade of the right eye, cherry red spot of the left eye within the macula, consistent with Purtscher-like retinopathy in the setting of acute pancreatitis declaring him legally blind. Patient signed a 302 to receive further inpatient psychiatric care. DISCUSSION: The patient's acute psychosis from alcohol compounded his complaint of acute vision loss. Purtscher retinopathy is a rare complication of acute pancreatitis. The etiology is unclear, however in relation to pancreatitis, the condition may be caused by complement induced granulocyte activity causing cotton wool spots, retinal hemorrhages, and papilledema [2]. It should be suspected if patients voice concern of decreased visual acuity. Previously high dose steroids have been used but there is no evidence that this treatment improves morbidity. Recovery of visual acuity is variable with some patients regaining vision with mild loss of acuity and others remain legally blind. Certainly, a rare and interesting complication of acute pancreatitis. CONCLUSIONS: Evaluation and treatment of patients with acute pancreatitis with visual complaints should raise concern for Purtcher's retinopathy. There are no current evidence-based treatment options. Close follow up with a retinal specialist is required. Further clinical studies are required to investigate treatment options for Purtcher's retinopathy. REFERENCE #1: Bissonnette B. Purtscher Disease. AccessAnesthesiology 2019. REFERENCE #2: C; CDRABFB. [Retinopathy in severe acute pancreatitis]. Oftalmologia (Bucharest, Romania : 1990). REFERENCE #3: Buckley, S. and James, B., 2020. [online] Pmj.bmj.com. Purtschers Retinopathy. [Accessed 7 July 2020]. DISCLOSURES: No relevant relationships by Abdelrhman Abo-zed, source=Web Response No relevant relationships by Melissa Chrites, source=Web Response No relevant relationships by Erica OKane, source=Web Response No relevant relationships by Syed Arsalan Zaidi, source=Web Response

A Rare Case of Thrombotic Thrombocytopenic Purpura Caused by Acute Pancreatitis

Thrombotic Thrombocytopenic Purpura is a syndrome of microangiopathic hemolytic anemia accompanied by thrombocytopenia, neurological disorders, renal failure and fever. Acute pancreatitis is a rare cause of Thrombotic Thrombocytopenic Purpura and this manifestation, at the same time, is a rare complication of acute pancreatitis. Thrombotic Thrombocytopenic Purpura is induced in acute pancreatitis by poorly understood mechanism, which involves multiple pathways apart from only ADAMTS-13 deficiency. Here, we analyze the case of a 47-year-old female who presented with an acute pancreatitis. She was diagnosed with Thrombotic Thrombocytopenic Purpura and an acute pancreatitis at the same time, with thrombocytopenia and peripheral smear findings at presentation. Therefore, Thrombotic Thrombocytopenic Purpura secondary to the pancreatitis was considered in this case. In this work, we have discussed details of our case and the different mechanisms involved in pathogenesis of Thrombotic Thrombocytopenic Purpura in acute pancreatitis and their outcome with prompt management.

Takotsubo cardiomyopathy complicating acute pancreatitis: a case report

BackgroundAcute pancreatitis as a trigger of Takotsubo cardiomyopathy has been infrequently described in the literature. Misdiagnosis of this phenomenon can often occur due to overlap in symptomology, particularly in those outside of the usual patient demographic.Case presentationA 27-year-old man with a history of alcohol abuse presented with epigastric and chest pain. Electrocardiography showed ischemic changes, and laboratory workup revealed elevated lipase and troponin. He was diagnosed with acute pancreatitis and managed presumptively as acute coronary syndrome. Subsequent coronary angiography was negative for obstructive coronary artery disease, and left ventriculography demonstrated basal hyperkinesis and apical akinesis, characteristic of Takotsubo cardiomyopathy.ConclusionsTakotsubo cardiomyopathy is a rare complication of acute pancreatitis. Increased awareness of this phenomenon is required to prevent delays in diagnosis and avoid unnecessary interventions and complications.

Case of Gastric Intramural Hematoma; Rare Complication of Acute Pancreatitis

Case of Gastric Intramural Hematoma; Rare Complication of Acute Pancreatitis

Unusual association between scrotal swelling and abdominal pain

A 54-year-old man experienced acute dull pain radiating from the left lower abdominal area for 3 days after binge drinking. He had an underlying condition of diabetes, hyperlipidemia, and alcohol abuse. The pain worsened following intake of food and water, and the pain was observed to progressively radiate toward the left inguinal area accompanied by swelling of the scrotum (Figure 1A). He visited the emergency department; the laboratory examination revealed leukocytosis (white blood cell count, 14 000 cells/mm3) and mild anemia (hemoglobin, 13.6 g/dL). Biochemical examination showed increased triglyceride levels (823 mg/dL) and increased lipase levels (104 U/L, normal range: 19-47). Ultrasound performed by a urologist suggested hydrocele without testicular torsion, epididymitis, or epididymo-orchitis (Figure 1B). This was followed by an abdominal computed tomography (CT) scan (Figure 2). What is the likely diagnosis of this patient? Based on the acute onset of symptoms and the progression of the clinical status, the differential diagnoses included testicular torsion, strangulated hernia, and epididymitis. The abdominal CT scan revealed pancreatic fat stranding with fluid accumulation in the left pararenal space along the left abdomen and extending into the left inguinal canal (Figure 2, arrows). Based on the clinical, laboratory, and imaging findings, a diagnosis of pancreatic hydrocele was established. The patient was placed on fluid supplement. The pain gradually improved, and he was discharged 5 days later. His scrotal swelling also gradually subsided during the 1-month follow-up period. Pancreatic hydrocele refers to scrotal swelling associated with acute pancreatitis.1-3 It is a rare complication of acute pancreatitis and is caused by the effusion of pancreatic juices into the inguinal canal along the retroperitoneal tract. This rare complication resembles other acute scrotal conditions such as testicular torsion, appendicular torsion, and epididymitis. Abdominal CT is useful for diagnosis, and ultrasound-guided aspiration of scrotal fluid showing high amylase and lipase levels can assist in confirming the presence of this condition. Treatment is generally conservative. Surgical drainage or debridement is rarely required.3 The authors declare no conflict of interest.

S1420 A Rare Case of Superior Mesenteric Vein Thrombosis as a Complication of Pancreatic Pseudocyst Fistulization

INTRODUCTION: Superior Mesenteric (SMV) Thrombus is a rare complication of acute pancreatitis, and multiple factors contribute to its formation, including underlying inflammatory along with venous compression leading to venous stasis. Here, we present a unique case of an SMV thrombus as a result of a pancreatic pseudocyst to SMV fistula in the setting of chronic pancreatitis. CASE DESCRIPTION/METHODS: Patient is a 61-year-old male with a past medical history significant for chronic pancreatitis secondary to chronic alcohol abuse who presented with multiple episodes of nausea and non-bloody, non-bilious vomiting. Labs were notable for a lipase of 161 U/L and an alcohol level >300 mg/dL. Interestingly, the patient denied any abdominal pain, and the physical exam was unremarkable, with a soft, non-tender, non-distended abdomen noted with active bowel sounds. Computed Tomography (CT) Abdomen showed chronic calcific pancreatitis with a 2.5 cm hypodense pancreatic head mass with a proximal SMV thrombosis. Magnetic Resonance Imaging (MRI) Abdomen noted the mass to be a pseudocyst rather than a primary pancreatic malignancy with visualization of a wide connection between the cyst and the adjacent SMV with resultant thrombosis of the SMV, compatible with fistulization. Furthermore, imaging did not reveal acute pancreatitis, attributing visualized fat stranding to the thrombus. Surgery recommended initiation of anti-coagulation, therefore the patient was started on a heparin drip and discharged on apixaban with close surgical follow-up. DISCUSSION: Splanchnic vein thromboses are seen in less than 2% of patients with acute pancreatitis, the majority of these involving the splenic vein, and rarely, the SMV. The pathogenesis for these thrombi is thought to be from the combination of direct damage to the venous wall by freed pancreatic enzymes and compression of the vein by the inflamed pancreas. SMV thrombosis is often diagnosed incidentally on imaging, however, it has a high mortality rate of up to 20–50% due to the risk of small bowel ischemia, therefore anti-coagulation should be considered in these cases. Uniquely in our case, the pathogenesis of the SMV thrombus included a fistula between the pancreatic pseudocyst and the SMV, which has been scarcely reported, in the setting of chronic pancreatitis rather than an acute flare. Our case also warrants the question regarding the utility of longitudinal follow-up with serial imaging in those with chronic pancreatitis to prevent fatal outcomes, including bowel ischemia.Figure 1.: CT Abdomen W Contrast 3 cm round mass is seen in the pancreatic head [red arrow], with peripheral calcifications indicating chronic pancreatitis [green arrow]. The Superior Mesenteric Vein (SMV) is in close proximity with the pancreatic mass [yellow arrow].Figure 2.: MRI Abdomen W WO Contrast (T2WI AXIAL) Revisualization of the mass in the pancreatic head with dependent debris [red arrow]. There is also fistulization from the pseudocyst into the superior mesenteric vein (SMV) [green arrow].Figure 3.: MRI Abdomen W WO Contrast (T2WI CORONAL) Mass in the pancreatic head is T2 hyperintense without wall nodularities, clearly constituting a cyst [red arrow]. There is fistulization into the Superior Mesenteric Vein (SMV) [green arrow] followed by thrombosis [blue arrow].

A Rare Complication during Salmonella sp. Infection in a 4-Year-Old Child: Acute Pancreatitis

Abstract Objective We aimed to report a rare complication of acute pancreatitis which developed during Salmonella infection. Methods We report a 4-year-old girl with pancreatitis that occurred after salmonella gastroenteritis. Discussion Salmonella sp. infections cause serious mortality and morbidity worldwide. Salmonella transmission is mostly fecal oral from contaminated water and foods. Acute pancreatitis expresses the acute inflammatory process of the pancreas. Inflammation of the pancreas associated with bacterial, viral, and fungal agents can lead to acute pancreatitis. There are limited data regarding the frequency of infections leading to pancreatitis. Here, a pediatric case with pancreatitis that occurred after salmonella gastroenteritis is reported. Conclusion Acute pancreatitis due to S. sp. infection is very rare in children. Pancreatitis should be considered in patients with gastroenteritis with typical abdominal pain.

Colonic obstruction: a rare complication of acute pancreatitis.

Colonic obstruction: a rare complication of acute pancreatitis.

Blind After a Binge: Purtscher-like Retinopathy in Acute Alcoholic Pancreatitis

ABSTRACTPurtscher-like retinopathy is an occlusive microvasculopathy that causes sudden onset vision loss of varying severity. The condition is a rare complication of acute pancreatitis and is scarcely documented in the literature. In addition, it is vision-threatening, and there are no evidence-based therapies available. We report a 37-year-old woman presenting with abdominal pain and nausea in the setting of heavy alcohol use. She was diagnosed with acute pancreatitis. During hospitalization, she developed acute visual disturbance and was found to have significantly diminished visual acuity. A dilated funduscopic examination demonstrated multiple retinal cotton wool spots bilaterally and macular edema. The patient was diagnosed with Purtscher-like retinopathy in the setting of acute pancreatitis. Although the prognosis for her vision was guarded, given the ischemic nature of the insult, she had subjective improvement in visual acuity during the remainder of the hospital course with symptomatic management.

An Unusual Case of Gallbladder Carcinoma with Pseudopancreatic cyst

Generally, carcinoma of the gallbladder is an extremely unusual neoplasm, however, high incidence rates have been reported in certain parts of the world. The role of certain factors such as genetic susceptibility, lifestyle and infections of gallbladder in causing carcinogenesis is still not clearly understood. Due to its early vague symptoms and lack of serosa in the gallbladder to slow its spread, gallbladder carcinoma typically presents at an advanced stage with a five-year survival rate of less than 5%. Pseudopancreatic cyst is an uncommon but not a rare complication of acute pancreatitis and injury to the pancreas. However, it rarely presents with carcinoma of gallbladder. We present here an unusual case of gallbladder carcinoma with pseudopancreatic cyst in a 58-year old male.